St. Elizabeth Manor, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ST. ELIZABETH MANOR, INC.

Practice address

111 Commercial Dr
Footville, WI 53537

Phone

(608) 876-4000

NPI assigned

Sep 9, 2020

Last updated

Sep 9, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julie Marks

Title

Cfo

Phone

(920) 206-4926

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599609600000",
    "number": "1295340016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COMMERCIAL DR",
            "city": "FOOTVILLE",
            "state": "WI",
            "postal_code": "53537",
            "telephone_number": "608-876-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COMMERCIAL DR",
            "city": "FOOTVILLE",
            "state": "WI",
            "postal_code": "53537",
            "telephone_number": "608-876-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ELIZABETH MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-09",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-206-4926"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Footville EMS Service
• Footville Fire Dept & EMS
• Osl Sem Operating LLC (Prairie View Manor)
• David Sulik, MANAGER

• Assisted Living Facility in Footville, WI
• Providers in Footville, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.